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Background and Aims Currently there is little published in the use of popliteal sciatic blocks (PSB) during distal limb angioplasty procedures in awake patients. We present a case directly comparing angioplasty under local anaesthetic alone, versus with PSB. A 70-year-old, ASA 3, male patient was scheduled for a tibial angioplasty, having undergone the same procedure on the contralateral leg a week prior. During pre-assessment, he reported experiencing unexpectedly severe pain during multiple arterial balloon dilatations in the first procedure. We offered a PSB for the second procedure, with the potential for alleviating intra-operative pain.

Methods We performed an ultrasound guided PSB of the right leg with 20ml of 0.75% Ropivicaine, which the patient tolerated well. We then surveyed the patient and the surgeons after the operation.

Results Intra-operatively, the patient did not show any signs of distress during arterial balloon dilatations, actually sleeping through most of the 2-hour procedure. Post-operatively, he reported his pain was 0/10 during the procedure versus 9/10 for his previous angioplasty (without PSB). He stated it was the ‘obvious choice’ to have a PSB for tibial angioplasty and was ‘surprised the PSB was not offered the first time’. Furthermore, the surgeon (who had performed both procedures) reported better, ‘incomparable’ operative conditions with PSB, as the patient was pain free and ‘more still’.

Conclusions This case demonstrates a clear advantage of PSB for tibial angioplasty for both patient and surgeons. These benefits have translated to surgeons at our institution increasingly requesting PSB for these operations.